FSS INTAKE FORM

FamilySupportScotland Intake Form

Welcome to FamilySupportScotland. We provide free, confidential advocacy for children, young people and families in Scotland.This form helps us understand your situation so we can support you safely and appropriately.You can complete as much or as little as you feel comfortable with.Your information is confidential and stored securely. We will never share information without your consent unless someone is at risk of harm.

Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityPhone number

Post CodeCountry
Email
example@example.com
Preferred way of contact
Who are you contacting about
If someone else, please give their name,age and relation to you.
What services are you looking for. Can pick more than one
If other, please write
Professionals Involved
I understand that FamilySupportScotland will keep my information confidential unless someone is at risk of harm or there is a legal requirement to share information.
I consent to FamilySupportScotland storing and using my information to provide support. I understand I can withdraw this consent at any time.
Consent to us contacting professionals
Do you consent to us attending meetings/panels with you
Where did you hear about us
We aim to respond within 24–48 hours. If your situation is urgent or someone is at immediate risk, please contact emergency services 101 or 999 or other appropriate 24/7 helpline listed on our website.
Book Appointment
Should be Empty:

FamilySupportScotland Intake Form